tbuckley/cabot-search huggingface dataset:
The Effect of Debulking Surgery after Induction Chemotherapy on the Prognosis in Advanced Epithelial Ovarian Cancer
Authors: Maria E.L. van der Burg, Mat van Lent, Marc Buyse, Anna Kobierska, Nicoletta Colombo, Giuseppe Favalli, Angel J. Lacave, Mario Nardi, Josette Renard, Sergio Pecorelli
Journal: New England Journal of Medicine (1995)

Although the value of primary cytoreductive surgery for epithelial ovarian cancer is beyond doubt, the value of debulking surgery after induction chemotherapy has not yet been defined. In this randomized study we investigated the effect on survival of debulking surgery.
Prospective controlled trial of selective parenteral and enteral antimicrobial regimen in fulminant liver failure
Authors: Nancy Rolando, Alexander Gimson, Jim Wade, John Philpott-Howard, Mark Casewell, Roger Williams
Journal: Hepatology (1993)

To compare the efficacy of a selective parenteral and enteral antimicrobial regimen in patients with fulminant liver failure, we classified 104 patients on reaching grade II encephalopathy as infected or noninfected. Patients who were infected were randomly assigned to receive IV cefuroxime (group 1) or selective parenteral and enteral antimicrobial regimen (group 2). Noninfected patients were randomly selected to receive either selective parenteral and enteral antimicrobial regimen (group 3) or no initial antimicrobials until clinically indicated (group 4). The four groups were comparable regarding age, sex, cause of disease, coma grade, international normalization ratio, presence of kidney failure and indicators of poor prognosis on admission to the study. Clinical parameters such as white cell count, temperature or changes in the chest radiograph, which were used to stratify patients into those infected or not, were not good predictors of infection because early infection rates were similar in the two groups. Three patients died within 24 hr and were excluded from the analysis. We found 42 microbiologically confirmed infections: group 1, 6 of 21; group 2, 8 of 21; group 3, 9 of 28; and group 4, 19 of 31. A reduction in infection was seen between groups 3 and 4 (p < 0.05). Patients receiving the selective parenteral and enteral antimicrobial regimen (groups 2 and 3) had fewer infections than the control group (group 4) (p < 0.005). Groups receiving early antimicrobial therapy (groups 1, 2 and 3) had a lower incidence of infection compared with group 4 (p < 0.0005). Overall, 55.5% survived, with no significant difference between the four groups. Of 36 patients who fulfilled criteria for liver transplantation, 15 of 24 patients who received early antimicrobials (groups 1, 2 and 3) and 3 of 12 control patients (group 4) underwent transplantation (p < 0.05). Selective parenteral and enteral antimicrobial regimen reduces the risk of infection in patients with fulminant liver failure, but this effect is probably related to the early administration of antimicrobials. No reduction in length of stay in the unit or in the cost of antimicrobials was found. (HEPATOLOGY 1993;17:196–201.)
Massive Calcification of the Mitral Annulus
Authors: David Korn, Roman W. DeSanctis, Stewart Sell
Journal: New England Journal of Medicine (1962)

CALCIFICATION of the annulus fibrosus of the mitral valve is commonly found in older people at autopsy.1 2 3 4 5 6 7 8 Although this process can be a sequela of rheumatic,7 , 8 rheumatoid9 and other types of endocarditis, pathological evidence of previous inflammation is often absent.10 , 11 The lesion is generally regarded as the end stage of a degenerative process.1 2 3 4 5 6 7 8 Recently, severe calcification of the mitral annulus, with resultant anatomic deformity of the orifice, has been found in 5 patients at the Massachusetts General Hospital at post-mortem examination. In none was there pathological evidence of healed rheumatic heart disease. These unusual findings stimulated a search of the . . .
Efficacy and safety of on‐demand versus daily rupatadine in chronic spontaneous urticaria: A randomized trial
Authors: Karsten Weller, Ana Maria Gimenez‐Arnau, Jens Baron, Randolf Brehler, Marta Ferrer, Adriane Groffik, Sonja Grundmann, Thilo Jakob, Moisés Labrador‐Horrillo, Sabine Müller, Petra Staubach, Gerda Wurpts, Martin Metz, Marcus Maurer
Journal: Allergy (2023)

Abstract Background Non‐sedating H 1 ‐antihistamines (nsAH) are the most commonly used treatment for chronic spontaneous urticaria (CSU). Many patients use them as on‐demand (OD) therapy rather than a maintenance treatment. Here, we compared OD versus daily maintenance treatment with the nsAH rupatadine, assessed the efficacy of rupatadine updosing, and investigated potential long‐term disease‐modifying effects. Methods This multicenter, randomized study consisted of 2 weeks of screening, 8 weeks of double‐blind treatment, and 6 weeks of treatment‐free follow‐up (OD allowed). Adult patients were randomized to 10 mg rupatadine OD or 10 mg rupatadine daily. At Week 4, if patients did not have a complete response, they switched from 10 to 20 mg rupatadine daily or underwent sham updosing (patients on 10 mg rupatadine OD). The primary aim was to compare CSU disease activity at the end of follow‐up between daily versus OD. Additionally, we assessed the efficacy of rupatadine updosing. Major outcomes were disease activity, CSU‐related quality of life (QoL), and disease control. Results At Week 4, disease activity and QoL significantly improved in daily versus OD‐treated patients. Updosing of rupatadine did not improve the mean disease activity, but the number of complete responders increased during updosing from 5% to 22%. At the end of follow‐up, the disease activity of patients treated OD versus daily was not significantly different. Conclusions Daily rupatadine treatment significantly improved CSU disease activity and QoL during treatment versus OD treatment but not after discontinuation of rupatadine, indicating the benefits of a daily maintenance nsAH schedule.
Wound care for patients with hidradenitis suppurativa: Recommendations of an international panel of experts
Authors: Divya Chopra, Nimay Anand, Shandi Brito, Patricia M. Coutts, Ralph George, Alexa B. Kimball, Robert S. Kirsner, Afsaneh Alavi, Hadar Lev-Tov
Journal: Journal of the American Academy of Dermatology (2023)
Effect of intraoperative noise on postoperative pain in surgery patients under general anesthesia: evidence from a prospective study and mouse model
Authors: Shuai You, Fang Xu, Xiwen Zhu, Siyu Qin, Xuemei Zheng, Chengkun Tao, Yingcai Wu, Yupei Chen, Bin Shu, He Huang, Guangyou Duan
Journal: International Journal of Surgery (2023)

Background: Most patients are in a noisy environment during abdominal surgery under general anesthesia. This study included patients who underwent abdominal surgery under general anesthesia and established an animal model to determine whether intraoperative noise affects postoperative pain. Materials and methods: This prospective study included 200 patients who underwent abdominal surgery under general anesthesia. Intraoperative noise and electroencephalograms were continuously recorded, and the mean level and time proportion of noise intensity of greater than 70 dB were calculated. Maximum postoperative pain was assessed using a numerical rating scale at 0–12 h and 12–24 h after surgery, and postoperative analgesia consumption in patients receiving patient-controlled intravenous analgesia was recorded. Postoperative pain intensity and electroencephalogram amplitude were compared between patients with high-noise exposure (time proportion of noise intensity greater than 70 dB ≥40%) and low-noise exposure (&lt;40%). Mechanical pain sensitivity was tested in two groups of mice with plantar incisions exposed to 40 dB or 70–100 dB. Results: The time proportion of noise intensity greater than 70 dB was identified as an independent risk factor for postoperative pain intensity ( P &lt;0.001). P ain numerical rating scale 0–12 h (4.5±1.5 vs. 3.7±1.3, P =0.001) and 12–24 h (3.9±1.5 vs. 3.2±1.1, P =0.004) after surgery in patients with high-noise exposure was significantly higher than in patients with low-noise exposure. The electroencephalogram amplitude of patients with high-noise exposure was significantly lower than that of patients with low-noise exposure ( P &lt;0.05). In the mouse model, mechanical hyperalgesia in the 70–100 dB group was significantly greater than that in the 40 dB group ( P &lt;0.001). Conclusion: High-level intraoperative noise exposure aggravates the degree of postoperative pain and analgesic needs of patients undergoing abdominal surgery, which may be related to the impact of noise on the neurophysiological activity of the brain and postoperative hyperalgesia.
Exploring the complex relationship between vitamin K, gut microbiota, and warfarin variability in cardiac surgery patients
Authors: Ling Xue, Rajeev K. Singla, Qiong Qin, Yinglong Ding, Linsheng Liu, Xiaoliang Ding, Wenhao Qu, Chenrong Huang, Zhenya Shen, Bairong Shen, Liyan Miao
Journal: International Journal of Surgery (2023)

Background and objectives: Due to the high individual variability of anticoagulant warfarin, this study aimed to investigate the effects of vitamin K concentration and gut microbiota on individual variability of warfarin in 246 cardiac surgery patients. Methods: The pharmacokinetics and pharmacodynamics (PKPD) model predicted international normalized ratio (INR) and warfarin concentration. Serum and fecal samples were collected to detect warfarin and vitamin K [VK1 and menaquinone-4 (MK4)] concentrations and gut microbiota diversity, respectively. In addition, the patient’s medical records were reviewed for demographic characteristics, drug history, and CYP2C9, VKORC1, and CYP4F2 genotypes. Results: The PKPD model predicted ideal values of 62.7% for S-warfarin, 70.4% for R-warfarin, and 76.4% for INR. The normal VK1 level was 1.34±1.12 nmol/ml (95% CI: 0.33–4.08 nmol/ml), and the normal MK4 level was 0.22±0.18 nmol/ml (95% CI: 0.07–0.63 nmol/ml). The MK4 to total vitamin K ratio was 16.5±9.8% (95% CI: 4.3–41.5%). The S-warfarin concentration of producing 50% of maximum anticoagulation and the half-life of prothrombin complex activity tended to increase with vitamin K. Further, Prevotella and Eubacterium of gut microbiota identified as the main bacteria associated with individual variability of warfarin. The results suggest that an increase in vitamin K concentration can decrease anticoagulation, and gut microbiota may influence warfarin anticoagulation through vitamin K2 synthesis. Conclusion: This study highlights the importance of considering vitamin K concentration and gut microbiota when prescribing warfarin. The findings may have significant implications for the personalized use of warfarin. Further research is needed to understand better the role of vitamin K and gut microbiota in warfarin anticoagulation.
Enhanced recovery programme after colorectal surgery in high-income and low-middle income countries: a systematic review and meta-analysis
Authors: Naim Slim, Wai Huang Teng, Ealaff Shakweh, Helena-Colling Sylvester, Mina Awad, Rebecca Schembri, Shady Hermena, Manish Chowdhary, Ravi Oodit, Nader Francis
Journal: International Journal of Surgery (2023)

Background: Enhanced Recovery after Surgery (ERAS) protocols strive to optimise outcomes following elective surgery, however there is a dearth of evidence to support its equitable application and efficacy internationally. Materials &amp; Methods: We performed a systematic review and meta-analysis of studies on the uptake and impact of ERAS with the aim of highlighting differences in implementation and outcomes across high-income (HICs) and low-middle-income countries (LMICs). The primary outcome was characterisation of global ERAS uptake. Secondary outcomes included length of hospital stay (LOS), 30-day readmission, 30-day mortality and post-operative complications. Results: 337 studies with considerable heterogeneity were included in the analysis (291 from HICs, and 46 from LMICs) with a total of 110,190 patients. The weighted median number of implemented elements were similar between HICs and LMICs ( P =0·94), but there was a trend towards greater uptake of less affordable elements across all aspects of the ERAS pathway in HICs. The mean LOS was significantly shorter in patient cohorts in HICs (5·85 days versus 7·17 days in LMICs, P &lt;0·001). The 30-day readmission rate was higher in HICs (8·5% vs. 4·25% in LMICs, P &lt;0·001, but no overall world-wide effect when ERAS compared to controls (OR 1·00, 95% CI 0·88—1·13). There were no reported differences in complications ( P =0·229) or 30-day mortality ( P =0·949). Conclusion: Considerable variation in the structure, the implementation and outcomes of ERAS exists between HICs and LMICs, where affordable elements are implemented, contributing towards longer LOS in LMICs. Global efforts are required to ensure equitable access, effective ERAS implementation and a higher standard of perioperative care world-wide.
A comment on ‘Comparison of risk of complication between neuraxial anaesthesia and general anaesthesia for hip fracture surgery: a systematic review and meta-analysis’
Authors: Sandeep Bhushan, Han Cheng, Zongwei Xiao
Journal: International Journal of Surgery (2023)

Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017 Running Title: Comparison between NA and GA Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Published online ■ ■ *Corresponding author. Address: Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017. Tel: +86-15891442217. E-mail address: [email protected] (B. Sandeep). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/
Commentary on ‘Association of preoperative nutritional status evaluated by the controlling nutritional status (CONUT) score with walking independence at 180 days postoperatively: a prospective cohort study in Chinese older patients with hip fracture’
Authors: Lunqing Pu, Xiaomei Su, Xiaoxi Wang, Tongqing Pu, Yun Dong, Xuemei He, Lan Shen
Journal: International Journal of Surgery (2023)

Pu, Lunqing MD; Su, Xiaomei MM; Wang, Xiaoxi MM; Pu, Tongqing MM; Dong, Yun MD; He, Xuemei MD; Shen, Lan MD Author Information
Commentary on ‘A new clinical severity score for the management of acute small bowel obstruction in predicting bowel ischemia: a cohort study’ [Int J Surg 2023; 109:1620–28]
Authors: Zengwu Yao, Yifei Zhang, Lixin Jiang
Journal: International Journal of Surgery (2023)

aYantai Yuhuangding Hospital, Shandong University, Shandong Province, China bDepartment of Gastrointestinal Surgery, Yantai Yuhuangding Hospital affiliated to Qingdao University, Shandong Province, China cGeneral surgery, Yantai Yeda hospital, Shandong Province, China Zengwu Yao and Yifei Zhang contributed equally to this work and should be considered co-first authors. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article Published online ■ ■ *Corresponding author. Address: No. 20, Yuhuangding East Road, Zhifu District, Yantai, Shandong Province. Tel: +86-0535-6691999-83730. E-mail address: [email protected] (L. Jiang). This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-sa/4.0/
A commentary on ‘Leveraging diverse cell-death patterns to predict the prognosis and drug sensitivity of triple-negative breast cancer patients after surgery’
Authors: Jialin Li, Jing Yang
Journal: International Journal of Surgery (2023)

Department of Pathology, the First Affiliated Hospital of Jinzhou Medical University Data are publicly available. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Published online ■ ■ *Corresponding author. Address: Department of Pathology, the First Affiliated Hospital of Jinzhou Medical University E-mail address: [email protected] (J. Yang). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/
High visceral fat-to-muscle ratio predicated a recurrent fistula after definitive surgery for a small intestinal fistula with diffuse extensive abdominal adhesions: a cohort study
Authors: Weiliang Tian, Xin Xu, Risheng Zhao, Tao Tian, Wuhan Li, Ming Huang, Yunzhao Zhao, Zheng Yao
Journal: International Journal of Surgery (2023)

In patients diagnosed with sarcopenia, the presence of chronic preoperative inflammation, assessed by the ratio of the visceral fat area (VFA) to the total abdominal muscle area index (TAMAI) (VFA/TAMAI), has been found to adversely affect wound healing. An elevated VFA/TAMAI may contribute to a higher incidence of postoperative recurrent fistulas (RFs) following definitive surgery (DS) for small intestinal fistulas accompanied by diffuse extensive abdominal adhesions. The objective of this study was to evaluate the predictive value of VFA/TAMAI for postoperative RFs.The study enrolled 183 sarcopenic patients, with a median age of 51 years [interquartile range (IQR): 38-61 years), a median body mass index of 19.6 kg/m 2 (IQR: 18.9-21.0 kg/m 2 ) who underwent DS for small intestinal fistulas between January 2018 and October 2022 were included in the multicenter study. The outcomes assessed were RFs and postoperative length of stay (LOS). VFA/TAMAI was examined as a potential risk factor for each outcome.Out of the 183 patients, 20.2% ( n =37) developed RFs. The multivariate regression analysis identified VFA/TAMAI as the sole factor associated with RFs [odds ratio=1.78, 95% confidence interval (CI): 1.09-2.87, P =0.02]. The multivariable Cox regression analysis demonstrated that an elevated VFA/TAMAI was linked to a reduced postoperative LOS (hazard ratio=0.69, 95% CI: 0.59-0.81, P <0.001).In sarcopenic patients, a high VFA/TAMAI predicated the occurrence of RFs after DS for small intestinal fistulas in the presence of diffuse extensive abdominal adhesions.
A commentary on ‘Incidence, risk factors, prevention and treatment of postmastectomy pain syndrome in breast cancer: a multicenter study’
Authors: Yuxin Hou, Wei Ma, Yinyan Li
Journal: International Journal of Surgery (2023)

aDepartment of Ultrasound, the First Hospital of China Medical University, Shenyang, 110001, China bDepartment of Breast Surgery, the First Hospital of China Medical University, Shenyang, 110001, China This is a commentary, no original data is reported. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Published online ■ ■ *Corresponding author. Address: Department of Ultrasound, the First Hospital of China Medical University, Shenyang, 110001, China. E-mail address: [email protected] (Y. Li). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/
Clinico-characteristics of patients which correlated with preferable treatment outcomes in immunotherapy for advanced hepatocellular carcinoma: a systematic review and meta-analysis
Authors: Yani Wang, Wanyee Lau, Yafei Li, Yichen Tian, Yongrong Lei, Jianhua Wang, Feng Xia
Journal: International Journal of Surgery (2023)

Hepatocellular carcinoma (HCC) is the third-most lethal malignant tumor worldwide. The rapid development of immunotherapy utilizing immune checkpoint inhibitors for advanced HCC patients has been witnessed in recent years, along with numerous randomized clinical trials demonstrating the survival benefits for these individuals. This systematic review and meta-analysis aimed to identify specific clinico-pathological characteristics of advanced HCC patients that may lead to preferable responses to immunotherapy in terms of overall survival (OS), progression-free survival (PFS), and objective response rate (ORR).The included clinical trials were retrieved from PubMed, Embase, the Cochrane library, and the Web of Science databases published in English between 1 January 2002 and 20 October 2022. A systematic review and meta-analysis for first-line and second-line phase II/III studies were conducted on immunotherapy for patients with advanced HCC by using OS as the primary outcome measure, and PFS and ORR as the secondary outcome measures to obtain clinico-pathological characteristics of patients which might be preferable responses to programmed death-1 (PD-1) and programmed cell death-Ligand 1 (PD-L1) inhibitors. Toxicity and specific treatment-related adverse events (TRAEs) were also determined.After screening 1392 relevant studies, 12 studies were included in this systematic review and meta-analysis to include 5948 patients. Based on the analysis of interaction, the difference in OS after first-line immunotherapy between the subgroups of viral hepatitis [hazard ratio (HR)=0.73 vs 0.87, P for interaction=0.02] and macrovascular invasion and/or extrahepatic spread (HR=0.73 vs 0.89, P for interaction=0.02) were significant. The difference in PFS between the subgroups of viral hepatitis was highly significant (pooled HR=0.55 vs 0.81, P for interaction=0.007). After second-line immunotherapy, the difference in ORR between the subgroups of Barcelona Clinic Liver Cancer was significant (pooled ES=0.12 vs 0.23, P for interaction=0.04). Compared with PD-L1 inhibitors, PD-1 inhibitors may have a higher probability to cause TRAEs. Diarrhea, increased aspartate aminotransferase, and hypertension were the top three TRAEs.This systematic review and meta-analysis represents the first pilot study aimed at identifying crucial clinico-pathological characteristics of patients with advanced HCC that may predict favorable treatment outcomes in terms of OS, PFS, and ORR to immunotherapy. Findings suggest that patients with viral hepatitis positivity (especially hepatitis B virus) and macrovascular invasion and/or extrahepatic spread may benefit more in OS when treated with PD-1/PD-L1 immune checkpoint inhibitors.